This research will test the effects of a novel early intervention program to prevent childhood obesity. Nurses will deliver interventions to first-time parents and their infants at three home visits in the first year after birth followed by annual clinical research center visits until age 3. National Health and Nutrition Examination Survey (NHANES) data demonstrate the need for early intervention to prevent obesity: from 2007 to 2008, over 10 percent of children less than 2 years were already obese and over 20 percent of children between ages 2 and 5 years were overweight or obese. These findings are cause for concern because overweight infants and toddlers and those with rapid infant growth are at increased risk of obesity and its co-morbidities later in life. Further, attempts to prevent and treat obesity with older children have had limited success. In contrast, infancy may be an opportune time to begin obesity prevention. It is a critical period of rapid growth and developmental plasticity with long-lasting metabolic and behavioral consequences. Based on promising pilot study results and using an ecological/developmental framework, the proposed research seeks to deliver and test a program to prevent childhood obesity in a two arm randomized trial that includes a child safety control program. The obesity prevention program focuses on messages of responsive feeding, division of feeding responsibility, and healthy dietary choices that extend from infancy through age 3 years. As such, the intervention will teach first-time parents a) to recognize infant hunger and satiety cues and use feeding more selectively in response only to hunger, b) to use alternative soothing strategies to feeding for the fussy, but non-hungry infant and toddler, c) to provide children with appropriate portions of healthy foods and allow children to determine the amount consumed, and d) how to improve acceptance of developmentally appropriate foods such as vegetables through repeated exposure. This information is especially important during the first year after birth as infants make a dramatic dietary transition from the initial exclusive milk diet to one with many foods of the adult diet of their culture. During this transition, as foods are being introduced to children, there are numerous opportunities to address dietary content as well as parent feeding style. We propose to investigate the impact of our intervention on both intent to breastfeed and intent to formula feed mother-infant dyads. The intervention program is hypothesized to show efficacy in both breast and formula fed infants as measured by the primary outcome, body mass index (BMI) percentile at age 3 years. This outcome provides significant insight into long-term obesity risk. PUBLIC HEALTH RELEVANCE: The obesity epidemic in the United States continues to worsen, and there are few proven prevention strategies. Although infancy is a critical period for metabolic and behavioral development with long-term consequences, this period of life has largely been ignored as a target for obesity prevention. The proposed research will evaluate an innovative early intervention program for obesity prevention that will deliver several interventions to parents and their infants through home nurse visits.